Working with violent clients : staff explanations and actions

Abstract

The series of studies presented in this thesis test an attribution-emotionbehaviour model of helping versus violent retaliation (after Weiner, 1995) in professional groups at high risk of encountering violence in the workplace. Weiner's model predicts that staff who perceive violent incidents as within the control of the client will be more likely to experience anger and demonstrate a retaliatory response. Conversely, staff perceiving causes as uncontrollable by the client are more likely to feel sympathetic and exhibit helping behaviour. Emotional responses are seen to mediate between attributions and behavioural responses. A direct link between attributions of control and behaviour is also proposed. These predictions are tested in relation to violent incidents encountered by nursing staff working with detained patients in a psychiatric secure unit, and police firearms officers' in shoot-don't shoot training scenarios. Previous research investigating healthcare staff s perceptions of the causes of challenging patient behaviour reports mixed support for Weiner's (1995) model. Such research could be criticized for its' almost total reliance on the use of hypothetical scenarios, questionnaire methods, and lack of attention to the potential influence of client gender. The studies presented here are unique in that they not only assess spontaneous attributions and reported emotions of staff concerning their management of actual violent incidents, but also take gender into account. An initial pilot was followed by three studies, the first two of these included samples of healthcare staff working with detained patients in a secure unit, whilst the third examined firearms officers in training. The Leeds Attributional Coding System (LACS) was used to code 1) attributions made by healthcare staff in documentation concerning physical restraint of patients, 2) verbatim transcripts of interviews concerning real violent incidents in which heafficare staff had been involved, and 3) firearms officer debriefing interviews following simulated shoot-don't shoot scenarios. The findings from the first two studies suggest that different cognitive processes operate dependent on the gender of the client. In terms of the model tested, the proposed direct association between attributions of control and behaviour was supported, but for males only. Thus, where males were concerned, perceiving the client to have high control was associated with retaliation, and perceiving them to have low control was associated with helping. The role of emotion as a mediator was not supported for males or females. Some further support for the direct relationship between attributions of control and behaviour was found in the third study; police firearms officers' perceptions of high control for suspect were associated with increased frequency of shooting. It is concluded that attributions for client behaviour should be investigated in context, with consideration given to gender. Attributional models of helping/retaliation cannot be applied rigidly across different groups; it is necessary to consider the nature of the population and the circumstances under consideration. Possible explanations of the gender differences found are discussed.